Article by Bobby Miller | 2,264 words
Editor’s note: [The intention of this article is to introduce the reader to recent research on depression and its treatment. It is in no way a replacement to medical advice. If you would like more information about the disorder and its treatment, contact a medical professional in your area.]
Sayings like “Happiness is a choice” or “Don’t worry, be happy” do little for individuals whose brain chemistry has plagued them with major depressive disorder. This illness traps a person in emptiness, making every aspect of life feel like a waste. When diagnosed with depression, a person has no clue how long they might have to suffer with the condition, which only adds to their feeling of helplessness. Sure, help is available in the form of counseling or medication, but many patients do not find relief in these intervention programs.
However, scientists are delving into the neurological and physiological roots of depression to make existing treatments more effective while also exploring new means of alleviating the illness.
It’s in Your Blood
In September of 2014, Northwestern University published a study conducted by psychologists Eva Redei and David Mohr. These two scientists may have found an objective means of diagnosing depression and measuring how well treatment is working, without relying on the self-reports that patients provide.
Redei and Mohr’s test revolves around RNA molecules, which Northwestern’s press release describes as “the messengers that interpret the DNA genetic code and carry out its instructions.” By using a blood test, Redei and Mohr can examine the levels of nine RNA blood markers, which in turn provide a glimpse at the patient’s DNA.
Eva Redei and an assistant examine blood samples. Credit: Northwestern.edu
Looking at the RNA levels allows doctors to diagnose depression in patients who may be unwilling or unable to describe the full extent of their symptoms. After all, depression sometimes consumes people slowly, to the point that they may not recognize it as a serious medical condition rather than a horrible mood. There is usually “a two- to 40-month delay in [depression] diagnosis,” Northwestern University explains, “and the longer the delay, the more difficult it is to treat.” The blood test, however, “has the potential to provide a more timely and accurate diagnosis.”
Redei and Mohr’s discovery will also benefit people who already know full well that they’re depressed. The signs each RNA marker provides help predict who will benefit the most from cognitive behavioral therapy. This could aid doctors in deciding whether a patient should pursue counseling or opt for medicine. Plus, by administering the blood test multiple times, scientists can objectively measure how well a certain treatment method is working.
It’s in Your Genes
For a number of people suffering from depression, counseling isn’t enough to alleviate the condition. A psychiatrist needs to administer antidepressant medications as well. How, though, does a psychiatrist decide which drugs to prescribe? Unfortunately, since we don’t fully understand how antidepressants work, it’s largely trial and error. A patient tries a drug, and after a month or so, the psychiatrist listens to the individual describe how their symptoms have changed. They then decide whether to increase the dose, lower it, or try a different medicine altogether.
This can be a long, grueling process since it usually takes at least a month or two to gauge how well a medicine’s working. It can take years for some individuals to find a medication that lifts their mood without causing too many side effects. Trying over a dozen medications to no avail is not unheard of, and experiencing so many failures might make a person feel even more helpless.
The fact that administering antidepressants is mostly trial and error at this point is especially troubling considering how medications can drastically alter a person’s brain. A study published in the September 2014 edition of the journal Current Biology reveals that just a small dose of an antidepressant can change the connectivity throughout a person’s brain significantly in just three hours. Having to try many different medications, each of which radically alters the brain, can make the experience of depression even worse.
However, Assurex Health hopes to streamline the process of choosing medications for depressed individuals. This personalized medicine company has developed a technology called GeneSight, which was introduced nationally in 2011. “Using DNA gathered with a simple cheek swab, GeneSight analyzes a patient’s genes and provides individualized information to help healthcare providers select medications that better match their patient’s genes,” as the website GeneSight.com explains. In other words, a patient swabs the inside of their cheek (much like a paternity test) and in just a few days, they receive a form telling them which antidepressants are most likely to be effective and which ones are most likely to do nothing but cause troublesome side effects. Patients and psychiatrists can use the GeneSight results to help them decide which antidepressants to try.
GeneSight is also used for individuals with ADHD, bipolar disorder, schizophrenia, chronic pain and more. The test’s official website says that it has proven effective in treating a number of people. “Multiple clinical studies have shown that when clinicians used GeneSight to help guide treatment decisions, patients were twice as likely to respond to the selected medication.”
However, as many as 25 percent of depression patients do not show significant improvement from either talk therapy or medications. In cases when major depressive disorder refuses to let go of its victim, there are still other means of treatment that patients can pursue.
One available option is electroconvulsive therapy, often abbreviated as ECT. The therapy itself is nothing new. In fact, even the ancient Romans knew that electricity could affect the mind—before they knew what electricity was. Even though he lived from 10 BC to AD 54, “Roman Emperor Claudius pressed electric eels to his temples to quell headaches,” as The Wall Street Journal explains. People have also long known that causing somebody to have a seizure under controlled circumstances can actually have medical benefits. As the article goes on to note, “Sixteenth-century doctors induced seizures with [the chemical compound] camphor to treat psychiatric illnesses.” In the early twentieth century, scientists put these facts together and came up with the idea of electrically inducing seizures in patients to treat depression, schizophrenia, catatonia and other conditions.
Among many people, electroconvulsive therapy evokes images of sheer brutality. A scene in the famous book and movie One Flew Over the Cuckoo’s Nest shows the character McMurphy tied down on a hospital bed against his will as he’s given a painful shock in the head. However, ECT has evolved rapidly since 1975. Nowadays, doctors carefully pick which area of the brain to administer electricity to, and the patient is given an anesthetic so that they don’t feel a thing. Muscle relaxants are also used to ensure that the patient does not have any dangerous spasms during the treatment. Blood tests and a physical are also performed before the first ECT session to ensure that the patient can handle the anesthesia and the procedure itself safely.
Studies have shown that ECT is effective even in individuals who have not responded to many other forms of depression treatment. According to psychologist David Myers in his textbook Psychology in Modules, roughly 80 percent of people who go through about a dozen ECT sessions over the course of four weeks show significant improvement. This is a huge percentage considering that, as WebMD reports, each individual antidepressant only has a 28 percent success rate. Myers acknowledges that we’re not entirely sure why ECT works so well, but it might involve how the treatment boosts the production of new brain cells.
Although short-term memory loss is a common side effect of ECT, there is “no discernible brain damage,” as Myers explains. The more pressing concern is just how many people relapse after receiving this treatment. “ECT works very quickly but 50 percent or more people who receive this treatment will relapse within a year,” WebMD warns. For this reason, follow-up ECT appointments are usually scheduled after the first month’s initial dozen-or-so.
According to the Center for Women’s Mental Health website, which is run by the Massachusetts General Hospital, ECT is also a safe option for pregnant women. Since pregnant women can’t take many medicines, the procedure can be incredibly helpful for future mothers suffering from a psychological illness. However, extra precautions need to be taken to ensure that both the mother and her baby are safe during the procedure, as the website warns.
Despite the fact that ECT is considered a safe, ethical form of treatment today, it is usually reserved only for severe cases of depression where the patient has already tried counseling and many different medicines. However, since the therapy tends to work more quickly than medication, it’s sometimes administered to suicidal patients for their own safety.
A newer, less commonly used form of depression treatment involves activating the brain through magnets instead of electricity. Unlike ECT, it does not require any anesthesia, making the procedure accessible to a wider range of people. In fact, it may be a safer option for pregnant women.
Although the treatment is usually referred to as magnetic stimulation, the technical name is repetitive transcranial magnetic stimulation (rTMS). To stimulate the patient’s mind, “an electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation,” as the National Institute of Mental Health (NIMH) explains. “Then, short electromagnetic pulses are administered through the coil. The magnetic pulse easily passes through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.”
The hour-long procedure is painless and has not been found to cause any side effects. However, rTMS has not been around for even thirty years yet, so we cannot be entirely certain whether or not the procedure causes any long-term side effects. Also, the NIMH points out that scientists do not yet agree on which areas of the brain are the best targets for magnetic stimulation.
Psychologist David Myers warns that studies analyzing the effectiveness of magnetic stimulation have shown mixed results. However, the full body of available research suggests that it helps roughly fifty percent of patients. Since the procedure is relatively new, the success rate could improve as scientists investigate which parts of the brain are the best to stimulate.
Vagus Nerve Stimulation
There are even more forms of depression treatment that rely on stimulating the brain. In particular, although vagus nerve stimulation (VNS) has been used mostly for epilepsy treatment in the past, studies suggest that it could have beneficial effects for depressed individuals as well.
A pacemaker-like device “is attached to a stimulating wire that is threaded along a nerve called the vagus nerve,” as WebMD explains. “The vagus nerve travels up the neck to the brain where it connects to areas believed to be involved in regulating mood. Once implanted, this device delivers regular electrical impulses to the vagus nerve.” We don’t fully understand why this helps depression, but the electrical stimulation seems to affect chemical balances within the brain. However, clinicians usually prefer administering ECT and magnetic stimulation first since VNS requires surgery and often takes nine months to produce any beneficial effects.
The website HealthyPlace.com points out that various studies have shown VNS can help up to 43 percent of patients, though one study published in the journal Biological Psychiatry found beneficial effects in only 27 percent of patients. These effects were enough for the FDA to approve VNS for depression treatment in 2005, but some scientists question this decision. It’s possible that patients are improving after nine months or so not because of the VNS procedure, but rather due to the passing of time. After all, some episodes of depression, particularly less severe ones, calm down over time. With antidepressants, ECT and magnetic stimulation all available to treat depression without requiring surgery, VNS is not a widely used form of depression treatment.
Deep Brain Stimulation
Deep brain stimulation is a relatively new form of depression treatment that is currently available only on an experimental basis, according to MayoClinic.org. Basically, doctors implant electrodes within certain parts of the patient’s brain. “These electrodes produce electrical impulses that regulate abnormal impulses,” as the website explains. “Or, the electrical impulses can affect certain cells and chemicals within the brain.” The procedure could also benefit individuals suffering from Parkinson’s disease, dystonia, epilepsy, chronic pain and cluster headaches.
“Deep brain stimulation involves boring small holes in the skull to implant the electrodes,” MayoClinic.org explains, “and surgery to implant the device that contains the batteries under the skin in the chest.” The invasive surgery introduces a wide range of possible complications, ranging from brain hemorrhages to heart problems. Also, surgery will need to be performed again whenever the batteries in the stimulation device run out of energy.
Studies on the effectiveness of deep brain stimulation are quite limited, but the early results show that the risks could be well worth taking if an individual’s depression simply will not go away. “One small trial involving people with severe, treatment-resistant depression found that four out of six participants showed marked improvement in their symptoms either immediately after the procedure, or soon after,” according to the NIMH website.
Deep brain stimulation certainly has its risks, but for individuals suffering from depression, any ray of hope is a welcome one. As scientists continue to investigate the roots of major depressive disorder, perhaps those rays of hope will shine even more brightly.
More To Read: